2. What are the needs?  Patients ◦ health status ◦ health risks ◦ progress during treatment  Physicians ◦ treatment decision support ◦ trends in disease management ◦ financial management  Payers (commercial and government) ◦ understanding of the burden of disease (population perspective) ◦ assurance of quality for their customers/beneficiaries ◦ fiscal responsibility to the system

3. What are the elements of data-driven medical practice?  Clinical measures in addition to traditional claims statistics  Data grouped in clinically meaningful patient cohorts – something more than traditional ICD-9, CPT & DRG coding  Longitudinal data collected consistently over time  Data focused on measuring clinical outcomes and monitoring adherence to practice pathways  Integrated data from provider and payor partners – let’s all understand the big picture  Clinical improvements driven by continual performance feedback

4. What do effective clinical data systems need?  Logic ◦ organized around clinical thinking ◦ algorithm-based features  Usability (aka “user friendliness”) ◦ can people learn the processes  Some rigidity ◦ there must be a basic foundation and certain required functions that are common to all systems, ie “data definitions”  Some flexibility ◦ Data needs will evolve over time – the system needs the capacity to capture discrete data without substantive re-design ◦ Avoid gimmicks  Multi-lingual (actually, “machine” language) ◦ Can our black box talk to your black box?

5.  How does a practice implement an EHR? ◦ Choose an EHR ◦ Create a small committee of committed physicians and clinical users who will champion the system ◦ Get a top-flight consultant who knows the system ◦ Listen to the consultant ◦ Use the system as it is designed – there is no perfect system – get over it!  This may mean that you need to rethink your work flow – heavens! ◦ Establish consistency within the practice  EVERYone must use the system at a minimum threshold  Reach agreement on where and how data will be stored and retrieved – all users must comply ◦ It won’t happen over a weekend